| NPI | 1588866875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005085) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 0012079) |
| Enumeration Date | 2007-05-31 |
| Last Update Date | 2008-03-24 |